OSHA Compliance Needs Analysis

To better assess your needs, please take a moment to complete this brief questionnaire.

(This survey will take less than five minutes)



Tell Us About You and Your Organization

First Name:    

Last Name:    

Company Name:      

Phone Number:      (please include area code)

Street Address:      (include suite if applicable)

City, State & Zip:   

E-mail Address:    

How did you hear about our services?   

What kind of industry are you in?      


Does your organization incorporate a single facility or multiple facilities?




What is the square footage of the building(s) (approximate)? 


How many employees do you have (approximate)?      


What are some of your safety issues (i.e. forklifts, machine guarding, blood borne pathogens etc)?



Have you been audited by OSHA in the last three years?      


How soon would you like to get started?    



Please Choose True or False for Each Question

(If you do not know the answer to a question, please choose "False")

   We have a comprehensive corporate "Health & Safety Policy" manual plan in place

   We are familiar with local, State & Federal regulations and we abide by them

   We display the Federal "It's the Law" poster (or state equivalent) in a conspicuous place

   We have developed a comprehensive written safety inspection process

   We conduct written safety inspections on a regular basis (monthly?)

   We keep all OSHA records for a minimum of five years

   We keep records of employee injuries and illnesses using OSHA Forms 300, 300A and 301

  During February through April we display the OSHA Form 300A in a conspicuous place

   Annually we review our records, training, inspections and safety policies to make improvements

   We keep medical exposure records for 30 years + the duration of employment of the exposed employee

   We have current MSDS for all chemicals onsite

   We keep a chemical inventory list of all MSDS for 30 years

   We have completed a written job hazard analysis for all positions in our organization

   We conduct comprehensive training based on the employees exposure to workplace hazards

   We have developed a corporate policy for workplace violence and threats

   We have conducted an emergency evacuation drill within the last six months

   We have developed a floor plan that identifies emergency related features

   We have trained specific employees as floor captains (evacuation aids)


Rank the Following OSHA Compliance Issues:
(1 represents a "great challenge", 5 represents "not a challenge for my organization")

     Lack of management support

     Lack of employee support

     Lack of direction (I don't know what I'm supposed to do)

     I don't understand local, State and Federal government requirements

     I have no idea of what a Health & Safety Policy manual should look like

     Insufficient budget

     Not enough time (To many other responsibilities)

As a thank you for completing this questionnaire, we'd like to forward a

three part recorded series including:


Part 1 - Why did I receive a letter from

OSHA and what does it mean?


Part 2 - What should I expect when OSHA arrives?


Part 3 - How we can help your organization get

off OSHA's list and survive an audit.


In addition, a special report:

"Top 10 OSHA Mistakes and How to Avoid Them."

and also included, a worksheet for determining your DART rate.


Simply hit "Submit" and these reports will be sent.

Would you like us to prepare a no- obligation proposal for OSHA compliance services?

Yes - please!